Kratom (or Ketum) is a psychoactive plant preparation used in Southeast Asia. It is derived from the plant Mitragyna speciosa Korth. Kratom as well as its main alkaloid, mitragynine, currently spreads around the world. Thus, addiction potential and adverse health consequences are becoming an important issue for health authorities. Here we reviewed the available evidence and identified future research needs. It was found that mitragynine and M. speciosa preparations are systematically consumed with rather well defined instrumentalization goals, e.g. to enhance tolerance for hard work or as a substitute in the self-treatment of opiate addiction.

There is also evidence from experimental animal models supporting analgesic, muscle relaxant, anti-inflammatory as well as strong anorectic effects. In humans, regular consumption may escalate, lead to tolerance and may yield aversive withdrawal effects. Mitragynine and its derivatives actions in the central nervous system involve μ-opioid receptors, neuronal Ca2+ channels and descending monoaminergic projections. Altogether, available data currently suggest both, a therapeutic as well as an abuse potential.

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From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction

About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries.

In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.

Availability of HIV prevention and treatment services for people who inject drugs: Findings from 21 countries

Experience from the last decade in Colombia and Mexico suggests that violence increases when governments achieve their objective of beheading and fragmenting drug trafficking organizations (DTOs). In this paper I provide a theoretical framework to understand this behavior. Drawing elements from industrial organization, I model DTOs as firms that collude by not attacking each other in order to increase their profits. DTOs always collude when they interact repeatedly; thus, previous analyses focusing on a static Nash equilibrium miss an important part of the dynamics between DTOs. I show that a peaceful equilibrium arises if there are only a few DTOs that care enough about the future.

Policies resulting either in a larger number of DTOs or in more impatient leaders increase violence between DTOs without reducing supply. On the other hand, policies that reduce the productivity of DTOs, without directly attacking their leaders and fragmenting them, are more desirable since they can curb supply, although this comes at the cost of increased violence if the elasticity of demand is below a certain threshold. I calculate this threshold, which is a refinement of the value suggested by Becker et al. (2006) for consumer markets.

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Should drug policy be aimed at cartel leaders? Breaking down a peaceful equilibrium

More or less ten years ago, a small group of professionals from APDES were confronted with a new arena of action: the streets, the “open scenes” where the drug users spent most of their time… Despite the experts naming these life scenarios “open scenes”, the communities living there were considered as “hidden populations”. And why was that?

Because they were rarely in contact with the health and social structures, never having an opportunity to see a doctor or to have a chat with a social worker. These were people never touched by the long arm of the social-sanitary system.

Unknown and abandoned to their fate, these were people wandering from street to street. So these professionals
were challenged with a new set of obstacles, experiences and ways of approach which were completely new. For the first time in their lives, these “open” settings exposed them to a new way of engaging with the communities, quite distant from the secure base of their desk at the office.

This book gives an answer to many of the questions that might be asked about what an outreach worker actually does, what attitudes he/she should acquire, and it gives a broad overview of the different activities, knowledge, skills and attitudes the professional outreach worker in harm reduction should know of and be aware of. A lot of work lies behind this extensive overview: it is not only about doing outreach, but also describes the importance of being able to form relationships with service users, and with other service providers, in order to support service users and to create opportunities for change.

People will find this E-Book useful when training new outreach workers, and it will help to create debate and reflection for the more experienced workers, thus becoming even better at doing their work.

Professional profile of the outreach worker in harm reduction

Among the radical options that are often proposed for a drug policy reform is the creation of a system of licensed cannabis supply subject to taxation and regulation of supply and demand sides of the market. In this study, we consider a hypothetical reform of this kind and identify a long list of possible sources of net social cost and benefit that could result. We attempt to quantify them, using the concept of net external benefit as an evaluation criterion. Net external benefit is the total value in cash-equivalent terms of the costs and benefits that cannabis use imposes on society outside the user him/herself, and it therefore excludes the potential net benefits (‘enjoyment’) accruing to cannabis users in a reformed market.

Our evaluation is consequently conservative in that it contains an inherent bias in favour of the prohibitionist status quo. In our view, it is impossible with available UK evidence to produce a credible estimate of net consumption benefits. Despite the bias this entails, it gives a far more reliable picture of the policy question than the many widely-cited estimates of the “social cost of drug use”, which include internal costs (potential harms to drug users) but ignore completely the internal benefits which are the reason that recreational drugs are used in the first place.

The estimates underpinning our evaluation should not be seen as predictions of what would happen if such a policy were to be introduced in some future period, since they relate to the market situation as it existed in England and Wales in 2009/10, and they abstract from any transitional adjustments (and any accompanying transitional cost). We have not attempted to extend the evaluation to cover Scotland or Northern Ireland, since most of the data resources available to us cover England and Wales only.

In constructing the estimates, we consider a wide range of evidence and the difficulties involved in drawing conclusions from that evidence. We provide simple, largely subjective, quantitative indications of the degree of uncertainty involved in our estimates, some of which should be regarded as illustrative calculations rather than formal estimates. Our aim is not to produce a definitive cost-benefit analysis of a licensed and regulated cannabis market – which we believe to be impossible in the present state of knowledge – but to set out clearly the range of considerations that need to be considered in forming a view about this policy, and to indicate which aspects of the evaluation are likely to be critical to the outcome of a full cost-benefit analysis.

Licensing and regulation of  the cannabis market  in England and Wales: Towards a cost-benefit analysis

Modernising drug law enforcement - Report 5

Since the 1980s, there has been a major push in rhetoric and institution-building, emphasizing the centrality of attacking the financial lifeblood of drug trafficking networks and organised economic crimes. Much progress has been made in legislation and the creation of financial intelligence units.

However, easier guidance is needed on how to get information overseas, and delays in international cooperation lead to under-exploitation of financial investigation opportunities. This report makes no claim to be offering a certain route to success, but is offering an overview of some better and some false steps that have been undertaken in the field of drug law enforcement and financial investigation strategies.

MDLE report 5 - Drug law enforcement and financial investigation strategies

Modernising drug law enforcement - Report 4

The purpose of this report is not to present a comparative study of legal rules and policies pertaining to cannabis in these or other countries, but to examine an issue largely neglected in the academic literature and by those advocating drug policy reform: namely the practical implications of policing and enforcing these developments.

The report provides an overview of some of the many difficulties that may – and do – confront police services when tasked to implement such measures (including the exercise of discretion) through examination of the rules and experiences of four jurisdictions, namely, Australia, England and Wales, Portugal and Switzerland. Along with some examples from the USA, specific aspects of each case study are scrutinised with the intention of highlighting points likely to be of interest to policy makers and practitioners alike.

MDLE report 4 - Practical implications of policing alternatives to arrest and prosecution for minor cannabis offences

Modernising drug law enforcement - Report 6

This briefing paper explores the rationale behind aid distribution vis-à-vis counter-narcotics and emphasises some of the geopolitical reasoning often underpinning the delivery of aid packages. Second, the authors assess the impact of foreign aid on both the security and drug markets of traditional consumer states, and on countries on the drug supply side.

The briefing paper then focuses on the challenges of introducing demand and harm reduction practices into the design of aid packages and assesses competing narratives highlighting the juxtaposition of development and counter-narcotics priorities, and the clash between long-term objectives and benefits on the one hand and short-term ones on the other.

MDLE report 6 - Drug markets, security and foreign aid

PKNI has launched its first issue brief on the urgent need for access to prevention, treatment and Hepatitis C treatment for people who inject drugs in Indonesia.

The briefing maps the hepatitis C situation among our community and the national response to hepatitis C in Indonesia. Indonesia has one of the highest rates of viral hepatitis in Southeast Asia, with an estimated 7 million people infected with the hepatitis C virus. Of the estimated 105,784 people who inject drugs in Indonesia, more than two-thirds have HCV -- a rate that now far exceeds levels of HIV infection among our community.

Although there is no vaccine for hepatitis C, transmission is preventable, and infection is treatable and curable. Unfortunately, prices for supporting diagnostic tests and for antiviral treatment remain far out of reach of the most vulnerable and affected communities of drug users.

To ensure that prevention, treatment, and care services and appropriately targeted, the meaningful involvement of people who use drugs role in designing, implementing, monitoring and evaluating the program is crucial.

The urgent need for improved hepatitis C prevention, care and treatment for people who inject drugs in Indonesia 

Between 1906 and 1917 China (under the Imperial and then Republican regimes) enacted a highly effective intervention to suppress the production of opium. Evidence from British Foreign Office records suggest that the intervention was centred, in many areas, upon a highly repressive incarnation of law enforcement in which rural populations had their property destroyed, their land confiscated and/or were publically tortured, humiliated and executed. Crops were forcefully eradicated and resistance was often brutally suppressed by the military. As few farmers received compensation or support for alternative livelihood creation the intervention pushed many deeper into poverty. Importantly, the repressive nature of the opium ban appears to have been a contributing factor to the fragmentation of China, highlighting the counter-productivity of repressive interventions to reduce drug crop production.

This article revisits the national intervention by analysing its impact upon opium farming communities in China.

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Harms caused by China's 1906–17 opium suppression intervention

This report and the detailed tables present a first look at results from the 2012 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older. Both the report and detailed tables present national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products, with a focus on trends between 2011 and 2012 and from 2002 to 2012, as well as differences across population subgroups in 2012. NSDUH national estimates related to mental health and NSDUH State-level estimates related to both substance use and mental health will be published in separate releases in the fall of 2013.

Results from the US 2012 national survey on drug use and health: Summary of national findings and detailed tables

According to this UNODC report, more than 100,000 people were smuggled out of the region last year alone, generating over $15 million for organized criminal networks operating on the maritime crossing from the Horn of Africa. Ivory poaching, which results in up to 154 metric tons being taken annually, led to an additional $30 million in illicit revenue just from Asian markets. Drugs are an increasingly lucrative illicit trade.

The report - Transnational Organized Crime in Eastern Africa: A Threat Assessment - is aimed at highlighting the most pressing transnational organized crime threats facing the region. Looking at some of the key areas, this latest report focuses on four such concerns: migrant smuggling from Ethiopia and Somalia to Yemen and Saudi Arabia; heroin trafficking from South-West Asia to Eastern Africa; ivory trafficking through Eastern Africa to Asia; and Somali maritime piracy.

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